A paradigm shift in localized pancreatic cancer

Pancreatic cancer is a highly lethal disease with a gradually increasing annual incidence and is predicted to become the second leading cause of cancer-related deaths in the United States by 2030. The approach of localized (i.e., non-metastatic) pancreatic cancer is changing nowadays from a purely anatomy-driven approach, based on the presence and extent of vascular involvement, towards a multi-domain manner in which also tumor behavior (i.e., biology) and patient’s performance status (i.e., condition) are used for the clinical decision-making including treatment allocation and response evaluation: the A-B-C approach. In this thesis, different aspects of the A-B-C paradigm in localized pancreatic cancer have been studied, including disease staging (part I), indications for and regimens of neoadjuvant and induction therapy as well as subsequent response evaluation (part II), impact of advanced pancreatic surgery including indications for specific extended procedures and how to mitigate certain short- and long-term surgical complications (part III), postoperative decision-making and outcome with regard to pathological complete response and the value of adjuvant chemotherapy (part IV), and improvement of oncological and surgical treatment of locally advanced pancreatic cancer (part V).